groups like the American Red Cross and the National Disaster
Medical System — use interventions that include explaining
and normalizing people’s psychological reactions to an event,
meeting basic needs like food, clothing and shelter, connecting
survivors with support systems, and referring those in need to
more targeted psychological support.

Research also suggests that most people want to work out
their post-crisis life on their own, adds Patricia Watson, PhD,
who is senior educational specialist for the National Center
for PTSD at the University of California, Los Angeles, and an
assistant professor at Dartmouth Medical School.

“The general strategy for most disaster survivors is to
provide resources that can help them adjust to their post-disaster life, and if necessary, to help them accept it and
encourage them to continue to proceed step by step, day by
day,” says Watson, who with other psychologists summarized
the state of post-disaster intervention research in the September
2011 American Psychologist. “If they’re stressed out, it doesn’t
mean they’re weak or that their responses are ‘pathological,’”
she adds. “Disaster survivors have been through a lot, so stress
reactions are to be expected.”

Behavioral health triage

Today, the protocol used by most disaster organizations is based
on empirically tested behavioral health strategies. Among the
most common initial interventions is psychological first aid. Its
goals are to promote safety, stabilize survivors in basic ways and
connect survivors with additional resources, especially people
who exhibit distress or problems functioning immediately after
a disaster.

“Psychological first aid helps people start to pull together
again, and helps to mitigate their immediate emotional,
behavioral and physical signs of distress,” Hanbury says.

For people still traumatized several weeks after an event,
more intervention may be needed. This often comes in the
form of crisis counseling, a type of intervention provided by lay
and mental health professionals that is funded by the Federal
Emergency Management Agency and sometimes administered
by the Substance Abuse and Mental Health Services
Administration after presidentially declared disasters.

Crisis counseling, which lasts from one session to as many
as are needed, is “much more directive and pragmatic than
normal counseling,” says disaster researcher Lisa Brown, PhD,
of the University of South Florida. If you’re helping someone
who has lost a loved one process their reactions, for instance,
you will also address their practical concerns, such as finding
them reliable transportation or helping them fill out FEMA
paperwork.

“Most people recover within eight to 12 months after a
disaster, but my argument is, ‘Why would you want to struggle
alone when there are resources and people willing to help you
make that a shorter process?’” says Brown.

Another example of specialized, evidence-based crisis
counseling is Skills for Psychological Recovery, an intervention
developed at the request of the Substance Abuse and Mental
Health Services Administration by Watson, early intervention
researchers and colleagues at the National Center for PTSD
and the National Child Traumatic Stress Network. Tailored
to individual needs and flexible in content and number of
sessions, it is based on five elements of recovery first delineated
by Stevan E. Hobfoll, PhD, Watson and colleagues in a 2007
article in Psychiatry: promoting a sense of safety, calm, self- and
community efficacy, connectedness and hope.

Interventions to foster these outcomes include helping
survivors and family members to problem solve, to build
positive activities back into their lives, and to manage stress
through simple interventions such as breathing or writing in a
journal. Other strategies include reframing thinking about the
stressful aspects of life and building a healthy social support
network.

“That could be an aunt you haven’t talked to for years
but who was always nice and supportive, or another disaster
survivor who is struggling as much as you are — who
understands how hard things are,” Watson says.

One middle-aged survivor entered counseling after
Hurricane Gustav with problems related to diabetes, the recent
loss of her two sisters, a car she couldn’t afford to repair and an
expired driver’s license. Her counselors helped her connect with
doctors, seek new social support and renew her license online,
among other interventions, Watson says.

If a person is still struggling several months later, the model
calls for more intensive, specialized therapy. Some interventions
are more effective than others. Randomized controlled
trials find, for example, that tailored cognitive-behavioral
interventions help to reduce PTSD, depression and anxiety
among disaster survivors and first responders. Uncontrolled
studies show similar results for terrorism-related PTSD,
according to the American Psychologist article.

Who’s more vulnerable

In the wake of a disaster, it is also helpful to know who
statistically is most prone to psychological distress. Research
shows that people closer to the ground zero — be they
bystanders, first responders or members of the media — are
often at greater risk for stress reactions than those who were
farther away.

Other at-risk groups include children and teens, women,people who are socially isolated, those with financial hardships